ABSTRACT
Diabetes care is the right of every individual living with diabetes. In this communication, we describe the epidemiology of diabetes in India, draw parallels between democracy and diabetes, and call for the democratization of diabetes care. We highlight the three A’s – Accessibility, Affordability and Awareness—that are essential for democratic diabetes care and share best practices towards this end.
ABSTRACT
Oral semaglutide is the newest discovery, the first in class peptide in a pill. Sodium N-(8-[2-hydroxybenzoyl]amino)caprylate (SNAC), a small fatty acid, has been co-formulated with semaglutide, which facilitates its absorption from the gastric mucosa. It has 94% homology with human glucagon-like peptide 1 (GLP-1). It comes in three dose forms – 3 mg, 7 mg and 14 mg. It is given as once daily dosing and is recommended in adult type 2 diabetes mellitus patients as monotherapy when metformin is contraindicated or not tolerated and in combination with other oral antidiabetic drugs (OADs). In a phase 3 trial, it has been shown to reduce glycated hemoglobin (HbA1c) up to 1.5%, with weight reduction up to 5 kg with a 14 mg dose. There was nonsignificant risk reduction of 21% in 3-point major adverse cardiovascular events (MACE) and 51% and 49% risk reduction in cardiovascular (CV) deaths and all-cause mortality, respectively. Oral semaglutide was found to be superior to empagliflozin, sitagliptin and liraglutide in both glycemic control and weight reduction. It also exhibits many pleiotropic effects – reduced energy intake, anti-inflammatory and anti-atherosclerotic effect, to name a few. Nausea was the most common side effect which was experienced by only 15% to 20% of patients. It was mild-to-moderate and transient. Overall, oral semaglutide has shown its efficacy both early and late in the management of diabetes, irrespective of renal and hepatic impairment.
ABSTRACT
This case report describes the management of a patient with mismatch/disparity between his Fasting Plasma Glucose (FPG)/ Postprandial Glucose (PPG) levels with that of Glycosylated Haemoglobin (HbA1c) levels. This 43-year-old male patient with Type 2 Diabetes Mellitus (T2DM) was presented with increased urination and tiredness, especially in the evening hours, along with a tingling sensation in bilateral feet on and off, with leg pain since past 4 months. The patient was obese with a family history of cardiovascular disease. In this patient, SGLT2 inhibitors were found to be effective in addressing glycaemic variability without triggering hypoglycaemic risk. Continuous glucose monitoring system aided in understanding the blood glucose fluctuations caused by the diet. This case study indicated that careful evaluation and appropriate management using Ambulatory Glucose profile would aid in preventing complications in such patients and improve the overall clinical outcomes.
ABSTRACT
The case report describes the potential role of real-time Ambulatory Glucose Profile (AGP) in identifying and managing a patient with hyperglycemia. This 55-years-old male patient with type 2 Diabetes Mellitus (T2DM) was presented to the clinic with weakness, increased urinary frequency, with constipation for the past 3 months. The patient was a known case of T2DM for 10 years, along with dyslipidemia, hypertension, and obesity. The profile obtained from AGP revealed glucose fluctuations with post-prandial excursions. Consequently, the patient抯 treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with voglibose 0.2 mg bid with two meals, metformin 100 mg + dapagliflozin 10 mg combination with morning meals, and metformin 1000 mg with evening meals. The treatment for hypertension and dyslipidemia was continued. This case study indicates that CGM can help improve our understanding of glycemic patterns and can have a beneficial effect on glycemic control.